Derriford Hospital, Emergency Department, Derriford Rd, Plymouth, Devon PL6 8DH, UK.
Resuscitation. 2010 Sep;81(9):1142-7. doi: 10.1016/j.resuscitation.2010.04.007.
The Advanced Trauma Life Support system classifies the severity of shock. The aim of this study is to test the validity of this classification.
Admission physiology, injury and outcome variables from adult injured patients presenting to hospitals in England and Wales between 1989 and 2007 and stored on the Trauma Audit and Research Network (TARN) database, were studied. Patients were divided into groups representing the four ATLS classes of shock, based on heart rate (HR) systolic blood pressure (SBP), respiratory rate (RR) and Glasgow Coma Score (GCS). The relationships between variables were examined by classifying the cohort by each recorded variable in turn and deriving the median and interquartile range (IQR) of the remaining three variables. Patients with penetrating trauma and major injuries were examined in sub-group analyses.
In blunt trauma patients grouped by HR, the median SBP decreased from 128 mmHg in patients with HR<100 BPM to 114 mmHg in those with HR>140 BPM. The median RR increased from 18 to 22 bpm and the GCS reduced from 15 to 14. The median HR in hypotensive patients was 88 BPM compared to 83 BPM in normotensive patients and the RR was the same. When grouped by RR, the HR increased with increasing RR but there were no changes in SBP.
In trauma patients there is an inter-relationship between derangements of HR, SBP, RR and GCS but not to the same degree as that suggested by the ATLS classification of shock.
高级创伤生命支持系统对休克的严重程度进行分类。本研究旨在检验该分类方法的有效性。
对 1989 年至 2007 年期间在英格兰和威尔士的医院就诊的成年受伤患者的入院生理、损伤和结局变量，以及存储在创伤审核和研究网络（TARN）数据库中的变量进行研究。根据心率（HR）、收缩压（SBP）、呼吸频率（RR）和格拉斯哥昏迷评分（GCS），将患者分为代表 ATLS 休克四级的组。通过依次按每个记录变量对队列进行分类，并得出其余三个变量的中位数和四分位距（IQR），研究变量之间的关系。对穿透性创伤和严重损伤患者进行亚组分析。
在按 HR 分组的钝性创伤患者中，SBP 中位数从 HR<100 BPM 的 128mmHg 降至 HR>140 BPM 的 114mmHg。RR 中位数从 18 增至 22bpm，GCS 从 15 降至 14。低血压患者的 HR 中位数为 88 BPM，而血压正常患者的 HR 中位数为 83 BPM，RR 相同。按 RR 分组时，HR 随 RR 的增加而增加，但 SBP 没有变化。
在创伤患者中，HR、SBP、RR 和 GCS 的紊乱之间存在相互关系，但与 ATLS 休克分类所提示的程度不同。
